Covid-19 Rapid Response Grants

On March 19, nine days after the state of emergency was announced, RIZE provided 25 of our community partners across the Commonwealth with one-time, rapid response grants totaling $205,000 to help support – and show gratitude for – our colleagues providing clinical and direct care to our most vulnerable populations under extremely challenging circumstances.

In April, we received a $250,000 grant from the Boston Resiliency Fund that we matched in full. We immediately awarded grants to local residential treatment providers who are using the funds to support staff, develop IT infrastructure to pivot to telehealth services, and increase sanitation measures.

We also funded two COVID-related research projects to document successes and challenges and describe the important lessons for future iterations of addiction care in Boston and elsewhere. By gathering this information, and helping to design and fund innovative solutions, RIZE provided unrestricted assistance during a time of tremendous uncertainty.

Saving Lives: Improving Health

The overdose epidemic cuts across every facet of our society. It endangers not just one person – or one type of person – but entire communities. Such a broad crisis requires an equally broad response, with collaboration from stakeholders across different sectors. This was the approach with our inaugural grant program, Saving Lives: Improving Health, Redesigning Opioid Use Disorder Care. The goals are to establish or expand a system of low-threshold community-based programs, provide on-demand access to short-term treatment and support for long-term treatment, and to improve health and quality of life for individuals who suffer from OUD. Fifty-nine percent of patients in this cohort have unstable housing and 39% are diagnosed with a serious mental illness.

The results to date are promising. The following data are from Boston Health Care for the Homeless Program, Brockton Neighborhood Health Center, and Lynn Community Health Center. During the reporting period encompassing the last 18 months of the program, the grantees served a combined panel of 3,777 patients with OUD – a 20% increase from baseline. Of those patients, 1,297 (34%) were engaged in behavioral health care. Furthermore, 1,828 (48%) patients started medication for opioid use disorder (MOUD), a 61% increase from baseline. For these patients engaged in MOUD, 55% were retained in treatment after six months and 48% were retained after 12 months.

*Recovery in this model is defined as abstinence from non-prescribed opioids

Enabling Health: Enhancing Harm Reduction in Massachusetts

We are relentless in our efforts to achieve our long-term goal of zero stigma, zero deaths. We are committed to using every tool available to solve the overdose crisis, and harm reduction is one of those tools. Harm reduction is a pragmatic and compassionate approach to prevent or lessen the harms associated with substance use and other high-risk behaviors. Delivered by skilled workers in a variety of program models, harm reduction helps people experiencing substance use disorders get the services and resources they need to survive.

In October 2018, we awarded over $1 million to six organizations across the Commonwealth that are enhancing low-threshold harm reduction services in our Enabling Health: Enhancing Harm Reduction program. Grants were awarded to AIDS Support Group of Cape Cod, the Kraft Center for Community Health (Community Care in Reach), Fenway Health, Greater Lawrence Family Health Center, HRH413, and Life Connection Center. These grantees successfully engage individuals who struggle with active addiction and provide services like syringe exchange, naloxone distribution, and treatment navigation services for OUD.

Innovations in Anti-Racism Grant

Tackling the overdose epidemic requires recognition of the social determinants and structural inequities that contribute to substance use and addiction. It also requires acknowledgment of the racial and ethnic inequalities in our nation’s response to past drug epidemics, disparities in access to treatment, and the disproportionate number of Black, Brown, and Indigenous people and low-income individuals that end up in the criminal justice system.

According to a report by the Substance Abuse and Mental Health Services Administration, attention to the overdose epidemic has focused primarily on white suburban and rural communities. And the 2017 Massachusetts State Health Assessment Report found that Black non-Hispanic and Hispanic individuals are less likely to complete treatment than white non-Hispanics because the differences in economic resources and experiences with social services may place racial/ethnic minorities at a disadvantage in terms of meeting the demands of a structured treatment program.

In October, RIZE will award grants through an exciting new program – Innovations in Anti-Racism to Address the Opioid Crisis. Our vision is that this program will have meaningful and positive results in reducing racism and improving access to evidence-based addiction treatment by reducing the stigma and structural barriers faced by Black, Latinx, and Indigenous people.

Survey on Stigma in the Health Care Professions

To address stigma in the healthcare professions, RIZE, the GE Foundation, and Shatterproof, a national nonprofit organization dedicated to reversing the course of the addiction crisis, collaborated on a year-long, Massachusetts-wide project, “Opportunities to Increase Screening and Treatment of Opioid Use Disorder among Healthcare Professionals.” The goal was to understand and identify opportunities to overcome stigmas that prevent certain healthcare providers from screening and treating patients with OUD and close the treatment gap. The research found that stigma associated with OUD extends to the provider community, where a minority of providers are trained in addiction, find treating OUD satisfying, or want to work with OUD patients.

The insights and learning were used to identify concrete opportunities for stigma-reduction programs and behavior change interventions across and within medical specialties to increase screening and treatment of OUD.

Economic Impact Studies

Two reports commissioned by RIZE showed that the overdose epidemic is taking a profound toll on the Commonwealth’s economy, workforce, and state budget. The reports, the first of their kind in Massachusetts, also provided recommendations on how employers can help employees with opioid addiction by increasing access to treatment and recovery. The reports were released in forums attended by over 400 people and received wide media attention.

Through this program, RIZE is funding a research collaboration between the Boston Public Health Commission, the Institute for Community Health, and Boston Medical Center to examine the experiences and service-seeking behaviors of ethnically/racially diverse Boston residents in the thirty days following an opioid overdose. This research will promote a better understanding of the factors that influence access to treatment and identify opportunities for systems change, including the promotion of health equity.

A project led by Brandeis University is exploring how isolated physician networks can negatively impact care coordination and information sharing among physicians. The goal is to identify system-level factors associated with the development and sustaining of buprenorphine prescribing in a community, in particular structural properties of prescriber patient-sharing networks in which waivered physicians are embedded, and how these properties vary in relation to community demographics including racial/ethnic makeup.

These papers will be presented to the field in 2021.

Boston Teaching Hospitals Learning Community

Together in Recovery

Another RIZE initiative that is working to expand access to OUD treatment and address inequities in our healthcare delivery system is Together in Recovery: Supporting Informed Decisions (TiR). This Commonwealth-wide initiative seeks to address the philosophical divides that exist in the treatment of OUD, with the main divide seen as that between medication treatment and abstinence-based treatment. The goal is to promote an integrated treatment and recovery community in Massachusetts that champions evidence-based approaches, supports multiple pathways to recovery, and promotes person-centered care. The initiative is the first of its kind in Massachusetts and it challenges the longstanding, institutional misconceptions about treatment and recovery as well as establishes common ground among stakeholders.

TiR is steered by a “Change Team” of diverse influencers, who span peer, clinical, policy, family, and community roles. As key stakeholders, the Change Team is constructing the vision for TiR that will drive future transformation across communities. During this project, RIZE convened eight regional meetings and one Commonwealth-wide meeting to discuss the many challenges associated with the treatment of OUD with diverse groups of stakeholders. Over 300 people attended these meetings and represented employers, unions, the justice system, people in recovery, the faith community, legislators, and more. We heard about the barriers that exist for both people seeking treatment and those in long-term recovery, such as lack of access to care and community supports, the presence of stigma, and a lack of information about treatment options. This is particularly true for Black, Brown, and Indigenous people, rural communities, and individuals who have low income.

The collection of resources will launch in late October.